title: "Double-stick tape" technique for transposition of an offending vessel in microvascular decompression: technical case report.
abstract: BACKGROUND
  Severe hemifacial spasm caused by compression by a tortuous vertebral artery (VA) often is encountered and is difficult to treat. We describe a patient with hemifacial spasm caused by compression of the facial nerve by a tortuous VA. A simple and effective transposition approach, a "double-stick tape" technique, to the offending artery using a fibrin tissue-adhesive collagen fleece product (TachoComb) is reported.
  
  
  METHODS
  A 65-year-old woman presented with an 8-year history of right-sided facial spasms, including the orbicularis oculi and orbicularis oris muscles. MRI revealed a tortuous right VA indented into the pontomedullary junction. The right anterior inferior cerebellar artery (AICA) also contacted the proximal portion of the facial nerve. Surgical exploration with standard retrosigmoid craniotomy was performed. The offending VA was dissected away from the pontomedullary junction toward the cranial base. A small piece of TachoComb, with fibrin glue applied on the non-coated side of the fleece to make a "double-stick tape," was then placed on the ventral surface of the VA. Until the glue hardened, the VA was held away from the brainstem onto the dura of the petrous pyramid. After this procedure, AICA transposition was performed. The patient's symptoms were completely resolved immediately after surgery, and she remained asymptomatic at her 1 year follow-up visit.
  
  
  CONCLUSIONS
  The advantage of our "double-stick tape" technique is the simplicity of the procedure. The present technique is a feasible alternative for the treatment of hemifacial spasm caused by a tortuous VA.
authors.affiliation: Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan. tomoichi@cc.okayama-u.ac.jp
authors.forename: Tomotsugu
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Agari
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kurozumi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Maruo
authors.forename: Toru
authors.initials: T
authors.lastname: Satoh
authors.forename: Isao
authors.initials: I
authors.lastname: Date
mesh_terms: D000368:Aged; D005154:Facial Nerve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D008866:Microsurgery; D061145:Microvascular Decompression Surgery / Q000379:methods*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000601:surgery*